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Evidence Guide: FNSISV506 - Investigate insurance claims

Student: __________________________________________________

Signature: _________________________________________________

Tips for gathering evidence to demonstrate your skills

The important thing to remember when gathering evidence is that the more evidence the better - that is, the more evidence you gather to demonstrate your skills, the more confident an assessor can be that you have learned the skills not just at one point in time, but are continuing to apply and develop those skills (as opposed to just learning for the test!). Furthermore, one piece of evidence that you collect will not usualy demonstrate all the required criteria for a unit of competency, whereas multiple overlapping pieces of evidence will usually do the trick!

From the Wiki University

 

FNSISV506 - Investigate insurance claims

What evidence can you provide to prove your understanding of each of the following citeria?

Clarify brief and instructions

  1. Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required
  2. Check subject matter questions to be investigated
Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Check subject matter questions to be investigated

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Investigate claim

  1. Determine method of investigation
  2. Collect and organise required information to make logical case
  3. Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable
  4. Record all data and information progressively and accurately
  5. File and store securely all original documents, tapes, photographs and other material
  6. Prepare and communicate appropriate changes in brief or instructions
  7. Comply with any changes in brief or instructions
Determine method of investigation

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Collect and organise required information to make logical case

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Record all data and information progressively and accurately

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

File and store securely all original documents, tapes, photographs and other material

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Prepare and communicate appropriate changes in brief or instructions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Comply with any changes in brief or instructions

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Report on investigation

  1. Prepare and transmit comprehensive reports according to reporting guidelines
  2. Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person
  3. Give facts and justification for conclusions to insurer’s nominated person
  4. Make recommendations for action, with appropriate justifications, where required
Prepare and transmit comprehensive reports according to reporting guidelines

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Give facts and justification for conclusions to insurer’s nominated person

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Make recommendations for action, with appropriate justifications, where required

Completed
Date:

Teacher:		 Evidence:

 

 

 

 

 

 

 

Assessed

Teacher: ___________________________________ Date: _________

Signature: ________________________________________________

Comments:

 

 

 

 

 

 

 

 

Instructions to Assessors

Evidence Guide

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Clarify brief and instructions

1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

1.2 Check subject matter questions to be investigated

2. Investigate claim

2.1 Determine method of investigation

2.2 Collect and organise required information to make logical case

2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

2.4 Record all data and information progressively and accurately

2.5 File and store securely all original documents, tapes, photographs and other material

2.6 Prepare and communicate appropriate changes in brief or instructions

2.7 Comply with any changes in brief or instructions

3. Report on investigation

3.1 Prepare and transmit comprehensive reports according to reporting guidelines

3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

3.3 Give facts and justification for conclusions to insurer’s nominated person

3.4 Make recommendations for action, with appropriate justifications, where required

Required Skills and Knowledge

ELEMENT

PERFORMANCE CRITERIA

Elements describe the essential outcomes.

Performance criteria describe the performance needed to demonstrate achievement of the element.

1. Clarify brief and instructions

1.1 Clarify brief provided to investigator including facts of claim, insurer’s instructions and outcomes required

1.2 Check subject matter questions to be investigated

2. Investigate claim

2.1 Determine method of investigation

2.2 Collect and organise required information to make logical case

2.3 Carry out investigations in accordance with legislation, regulations and organisational operating procedures and codes of practice, if applicable

2.4 Record all data and information progressively and accurately

2.5 File and store securely all original documents, tapes, photographs and other material

2.6 Prepare and communicate appropriate changes in brief or instructions

2.7 Comply with any changes in brief or instructions

3. Report on investigation

3.1 Prepare and transmit comprehensive reports according to reporting guidelines

3.2 Provide copies of documents, tapes, photographs and other materials to insurer’s nominated person

3.3 Give facts and justification for conclusions to insurer’s nominated person

3.4 Make recommendations for action, with appropriate justifications, where required

Evidence of the ability to:

use appropriate investigation methodologies and maintain accurate records

comply with relevant legislation and regulatory requirements in investigating a claim

produce complete and accurate investigation reports

provide detailed scoping for investigating insurance claims including in-scope and out-of-scope areas

develop options to resolve issues or problems that have the potential to impact on work outcomes during investigations.

Note: If a specific volume or frequency is not stated, then evidence must be provided at least once

To complete the unit requirements safely and effectively, the individual must:

outline key requirements of industry sector legal obligations and organisational procedures in relation to investigating claims

describe and implement appropriate investigation methods including:

interviews

surveillance

internet research

document authentication

observation

identify key features of relevant legislation, regulatory guidelines and industry sector codes of practice as they apply to:

insurance contracts

consumer protection

privacy

insurance investigation

explain the importance of report writing conventions in insurance investigations.